Biomedical subjects
Publications and source records attributed to E C Smoot.
We have described a technique for elevating the injured pediatric hand for the patient who is nursed in a crib. This system allows full movement of the patient throughout the length of the crib with little danger for the potential of shoulder dislocation.
The craniofacial team at the University of New Mexico Medical Center in Albuquerque, New Mexico has treated a large population of Navajo Indians. Team awareness of the Navajo concept of health as man in balance with his environment has resulted in more expedient treatment of the Navajo children. An understanding of Navajo concerns with ghosts, skinwalkers, and rules for orderly living has allowed team members to integrate the family and the Navajo medicine man in caring for the children with craniofacial disease. Special concerns for informed surgical consent and genetic counseling of the Navajo are reviewed. Respect for the traditional Navajo healing ceremonies and special handling of disposed body parts in surgery are required of the health professionals caring for these people.
A case report of a cystic preauricular mass that changed in size and position with jaw movement is presented. This tumor proved to be a ganglion of the temporomandibular joint (TM) cyst, which is relatively rare. When a preauricular mass retrudes into the masseter muscle in jaw opening, pathological conditions associated with the TMJ should be considered. Ganglion cysts of the TMJ are a benign pathological entity which can mimic parotid tumors. Temporomandibular joint radiography and perhaps ultrasonography of the region are useful in the preoperative evaluation of preauricular masses. The TMJ ganglion cyst can be successfully treated by direct excision and repair of the joint capsule. This approach avoids the potential morbidity of a superficial parotidectomy.
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Explore the source record for details and available documents.
Explore the source record for details and available documents.
For breast reconstruction, we have found that breast symmetry can be created optimally when the patient is brought to a totally upright position with the trunk vertical and perpendicular to the floor. The size of the opposite breast can better be appreciated. Nipple and areola position can be determined accurately even with the patient asleep if she is brought to the upright position. The safety of the upright positioning is documented in our series but depends on planning with the anesthesiologist preoperatively and allowing time to move the patient cautiously. An anesthesia technique for intraoperative vertical positioning is reported.
Recurrent and chronic herpetic skin ulcers are associated with the persistence of virus in the dorsal root ganglia serving the respective dermatomes. Descriptions of surgical approaches to control herpetic skin disease have recently appeared in the medical literature. We report the successful excision and skin grafting of chronic genital ulcers. Our subsequent animal studies support our expectations that potential seeding and reinfection of the grafted skin can occur following graft reinnervation. This problem must be watched for following grafts of herpetic ulcers in humans.
Many patients undergoing breast reconstruction demonstrate skin deficiency and tightness in both the vertical and horizontal planes on the mastectomy side. Conventional elliptical-type skin designs for the latissimus dorsi musculocutaneous flap fail to provide the bidimensional skin augmentation required. We demonstrate a trilobe cutaneous pattern that allows both horizontal and vertical skin release and has led to an improved aesthetic result. The pattern can be applied in performing either the latissimus dorsi or the transverse rectus abdominis musculocutaneous flap.
A review of the identification of foreign body hand injuries is presented with criteria for removal of a foreign body in the emergency department. Indications for acute surgical intervention are presented, and expectant management is discussed.
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This report presents information received from a sampling of breast prosthesis fitters which is of importance to surgeons working with mastectomy patients. The characteristics of various types of external prostheses are described. Shop fitters relate their attitudes about patients, describe patients' reactions to cancer and surgery and the problems encountered in proper fitting, and discuss their limitations as counselors. Fitters' negative attitudes toward reconstruction mammaplasty are also presented. The authors discuss these attitudes and raise questions about appropriate interaction between surgeons and prosthesis fitters.
Anhydrous ammonia is a relatively common cause of chemical injuries. Most injuries are the result of accidental exposure, frequently in the course of work. Exposure to anhydrous ammonia may produce serious injury to the eyes, respiratory system, and integument. Anhydrous ammonia injuries occurring in a predominantly agricultural region are reviewed. The pathophysiology of anhydrous ammonia injury is reviewed. Therapeutic modalities are described. Guidelines to prevent or minimize injury are delineated.
Helicopter transportation of acutely injured or ill patients has become common practice at most major medical centers. However, its specific effectiveness in the transportation of acute-condition patients with burns has never been critically assessed. This study, for the period 1984 through 1988, evaluated the use of the helicopter for transportation of acute-condition patients with burns to a regional burn center for a rural area. It is concluded that helicopter transport within a 180-mile radius in a non-hospital-based system is not appreciably faster than is ambulance transport, and does not clinically benefit most burned patients. Consideration such as safety, cost, and working space are discussed. It is recommended that at least one of three criteria be met before helicopter transfer is considered for patients with burns: the surface area involved should be enough to require a formal fluid resuscitation, an inhalation injury should be present or suspected, or there should be a possible need for an escharotomy.
Methicillin-resistant Staphylococcus aureus (MRSA) isolates that were collected from 44 consecutive patients during 1 year in a community hospital were tested for susceptibility to five commonly used topical antibacterial agents. Agar-well susceptibility testing, which was based on zones of inhibition, was used to compare the effectiveness of the antibacterials against MRSA. Nitrofurazone was effective in inhibition of bacterial growth and was relatively inexpensive. Mupirocin was found to be effective but more costly for treatment of MRSA. Varying degrees of susceptibility to silver sulfadiazine, mafenide acetate, and bacitracin were noted in the cultures that were obtained at this medical center. On the basis of our findings from susceptibility tests compared with those of another center, we recommend that all hospitals undertake topical sensitivity testing of their MRSA isolates. Appropriate and effective topical antibacterial therapy can then be planned within each center.
Topical epinephrine/saline solution in a concentration of 1:100,000 in a spray bottle can be used to prepare skin graft donor sites for harvesting of split-thickness skin. Additional wetting of the dermal bed during harvesting achieves minimal blood loss. The spray application of epinephrine/saline solution is superior to the use of epinephrine/saline compresses placed after harvesting. Skin prewetting and continuous misting during harvesting avoid the establishment of vigorous bleeding in the dermal bed from which the skin is taken and thus lessen total blood loss.